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Liver failure in children with hepatitis A
D Debray1, P Cullufi, D Devictor
1Service d'Hépatologie Pédiatrique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Hepatology (Baltimore, Md.)
|October 27, 1997
Summary
Hepatitis A can cause severe liver failure in children. Rapid onset of liver failure may predict recovery, but low prothrombin time and high bilirubin indicate poor outcomes, aiding liver transplant decisions.
Area of Science:
- Pediatric Hepatology
- Viral Hepatitis
- Liver Transplantation
Background:
- Liver failure from hepatitis A is rare in children.
- Established criteria for pediatric liver transplantation in fulminant hepatitis A are unevaluated.
Purpose of the Study:
- To highlight the severity of hepatitis A-induced liver failure in children.
- To identify predictors of outcome in pediatric patients with hepatitis A.
- To evaluate criteria for liver transplantation in this population.
Main Methods:
- Retrospective chart review at a single French pediatric liver transplantation center.
- Analysis of 24 children with hepatitis A and liver failure over 15 years.
- Grouping patients by outcome: no encephalopathy, spontaneous resolution, or death/transplantation.
Main Results:
- The mean age of onset was 6.5 years.
- Rapid onset of liver failure post-jaundice correlated with better recovery without encephalopathy.
- Among 18 children with encephalopathy, prothrombin time <21% and serum bilirubin >400 µmol/L predicted poor outcomes.
Conclusions:
- Hepatitis A can present with severe liver failure in children.
- Prothrombin time <21% and serum bilirubin >400 µmol/L are key early indicators for liver transplantation decisions in pediatric fulminant hepatitis A.
- Further evaluation of transplant criteria in children is warranted.